MDR and XDR TB

Antitubercular drug symbols

  • H = Isoniazid
  • R = Rifampicin
  • Z = Pyrazinamide
  • E = Ethambutol
  • S = Streptomycin
  • Km = Kanamycin
  • Cm = Capreomycin
  • Lfx = Levofloxacin
  • Ofx = Ofloxacin
  • Mfx = Moxifloxacin
  • Eto = Ethionamide
  • PAS = Para-aminosalicylic acid
  • Cs = Cycloserine
  • Amx/Clv = Amoxicillin-Clavulanate
  • Bdq = Bedaquiline
  • Lzd = Linezolid

mdr xdr tb

Multiple Drug Resistance Tuberculosis (MDR TB)

Definition: MDR tuberculosis is defined as resistance to minimum H and R.

Standard regimen for MDR TB in Nepal:

  1. Aminoglycoside other than streptomycin
  2. 2 oral bacteriostatics (Ethambutol if sensitive + PAS and/or CS)
  3. Fluoroquinolone (Preferably Ofloxacin)
  4. Pyrazinamide
  5. Pyrazinamide and Aminoglycoside are discontinued in maintenance phase.

8(Km-Z-Ofx-Eto-E or Cs)/12(Ofx-Eto- E or Cs)

Mnemonic: ZEKOCs

  • Minimum of 4 drugs must be used
  • Minimum duration of therapy: 20 months
  • Can be extended to: 24 months

Extreme Drug Resistance Tuberculosis (XDR TB)

Definition: XDR tuberculosis is defined as resistance to H and R, all fluoroquinolones and atleast one injectable agent.

Standard regimen for XDR TB in Nepal:

  1. Aminoglycoside
  2. 2 2nd line oral bacteriostatic drugs (PAS and Cycloserine; high chances of resistance to Ethionamide)
  3. Fluoroquinolone (higher generation like moxifloxacin)
  4. Pyrazinamide
  5. Add-on (Class 5) drug: Amx/Clv, Bdq, Lzd
  6. Pyrazinamide and Aminoglycoside are discontinued in maintenance phase.

12 (Cm-Mfx-PAS-Cs-Amx/Clv-Z) / 12 (Mfx-PAS-Cs-Amx/Clv)

Mnemonic: ZAMP CC

  • Minimum of 6 drugs must be used
  • Minimum duration of therapy: 24 months
  • Can be extended to: 30 months

 

Reference:

NTP General TB Manual 3rd edition (2012)

NTP A Clinical Manual For Nepal 3rd edition (2009)

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